全凭静脉麻醉下脑电双频谱指数监测在术中知晓预防中的作用分析

目的探讨全凭静脉麻醉下脑电双频谱指数监测在术中知晓预防中的作用。方法选取择期手术外科全麻患者150例为研究对象。根据数字随机分组法将患者均分为观察组和对照组（n=75）。2组患者均进行全凭静脉麻醉,观察组采取BIS调控,对照组未采取BIS调控。比较2组患者不同时间点BIS值及术后知晓情况发生率。结果 2组患者BIS基础值、麻醉诱导时BIS值、清醒时以及拔管时BIS值差异无统计学意义;在手术开始时、手术过程中、麻醉结束时以及手术结束时观察组BIS值低于对照组,差异具有统计学意义（P〈0.05）。2组患者均无术中知晓发生,观察组怀疑知晓率为0,对照组为1.33%,2组比较差异具有统计学意义（P〈0.05）。结论全凭静脉麻醉下脑电双频谱指数监测能够有效指导术中麻醉,维持适当的麻醉深度,降低术中知晓发生率。     

氟马西尼用于全凭静脉麻醉术后催醒的临床研究

目的 研究在BIS监测下氟马西尼对全凭静脉麻醉术后催醒的临床效果.方法 60例择期在全凭静脉麻醉下行腹部手术患者,年龄40～60岁,ASA I～Ⅱ级,随机分为两组:N组为对照组,用生理盐水拮抗(n=30);F组用氟马西尼拮抗(n=30).两组均在手术结束后,患者在这个状态(自主呼吸恢复,BIS为60),F组给予氟马西尼0.007mg∕kg.N组静注等剂量的生理盐水.记录患者用药前(T0)、给药后1(T1)、3(T2)、5(T3)、10(T4)、30mi(n T5)的BIS、MAP、HR、OAA/S评分的变化情况;记录清醒时间、拔出气管导管时间;记录术后的不良反应.结果 在用药3min后F组的BIS、MAP、HR、OAA/S评分明显升高用药前及N组(P＜0.05);F组的清醒时间、拔出气管导管时间与N组比较明显缩短(P＜0.05),术后F组不良反应发生率与N组比较无统计学意义(P＞0.05).结论 氟马西尼能有效地促进全凭静脉麻醉病人术后苏醒,缩短术后苏醒时间,保证病人麻醉苏醒期间的安全.     

静吸复合与全凭静脉麻醉用于老年骨科手术的比较研究

目的:比较老年骨科手术中采用七氟烷静吸复合麻醉与全凭静脉麻醉的疗效。方法:选取68例行内固定手术患者,分为观察组和对照组各34例,观察组采用全凭静脉麻醉,对照组采用七氟烷静吸复合麻醉。分析血流动力学变化及术后麻醉恢复情况。结果:观察组SBP、DBP在血压最低时与基础值比较,差异有统计学意义(P0.05);对照组SBP在切皮及血压最低时较基础值比较,差异有统计学意义(P0.05),HR在切皮及血压最高时较基础值差异有统计学意义(P0.05);术后恢复情况两组比较差异有统计学意义(P0.05)。结论:在老年骨科手术中采用七氟烷静吸复合麻醉患者,术后麻醉恢复效果更好,更减轻患者的痛苦,提高患者的生命质量,值得广大医学工作者在临床中大力推广使用。     

全凭静脉麻醉下脑电双频谱指数监测在术中知晓预防中的作用

目的:探讨全凭静脉麻醉下应用脑电双频谱指数(BIS)监测术中知晓的发生情况,评价BIS监测对术中知晓的预防作用.方法:丙泊酚全凭静脉麻醉下行择期手术患者300例,随机分成A、B两组(n=150).两组患者均进行BIS监测,A组根据BIS值调控麻醉深度,确保麻醉期间BIS值<60;B组术中遮蔽BIS值,根据经验调控麻醉深...     

瑞芬太尼-异丙酚全凭静脉麻醉用于腹腔镜胆囊切除术的体会

目的 分析瑞芬太尼复合异丙酚全凭静脉麻醉在腹腔镜胆囊切除术的应用及临床疗效.方法 将我院80例择期行LC手术的患者随机分为静吸组及静脉组,静吸组采用静吸复合麻醉,静脉组采用全凭静脉麻醉.结果 两组手术时间、睁眼时间、拔管时间比较,差异无统计学意义(P＞0.05),拔管5min OAAS评分和术后恶心呕吐例数比较,差异有统计学意义(P＜0.05);两组在气腹后10min的HR、SBP、DBP及术毕HR比较,静吸组明显高于其诱导前基础值,差异有统计学意义(P＜0.05),静脉组无明显变化;气腹后10min、气腹结束及手术毕,静吸组的HR均明显高于静脉组,差异有统计学意义(P＜0.05).结论 瑞芬太尼-异丙酚全凭静脉麻醉用于LC,可控性强,术中血液动力学稳定,术后苏醒迅速彻底,各种不良反应和副作用轻,减轻了患者的痛苦,是一种安全、有效的快通道麻醉方法.     

脑电双频指数监测在老年患者腹部手术全身麻醉中的应用评价

目的：探讨脑电双频指数监测在老年腹部手术患者全身麻醉中的应用价值。方法：选择2012年8月至2013年8月间于我院接受全麻腹部手术的91例老年患者作为研究对象,根据是否采用BIS监测将患者分为观察组（n=41）与对照组（n=50）,观察并记录两组患者在全身麻醉诱导前、后,手术结束时,清醒拔管前、后5个时间点的心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）;记录术中麻醉药物用量、手术结束后清醒时间、拔管时间、复苏室停留时间,术后恶心、呕吐发生率,术后随访术中知晓以及术后认知功能障碍情况。结果：两组间性别比、年龄、手术时间比较,差异无统计学意义（P〉0.05）,两组内及两组间各时间点CVP比较,差异均无统计学意义（P〉0.05）。观察组内各时间点间HR、MAP比较,差异无统计学意义（P〉0.05）;对照组内全身麻醉诱导后、手术结束时与全身麻醉诱导前HR、MAP比较,差异有统计学意义（P〈0.05）。两组患者间全身麻醉诱导后、手术结束时HR、MAP比较,差异有统计学意义（P〈0.05）。两组间丙泊酚、维库溴铵、芬太尼用量比较,差异均有统计学意义（P〈0.05）;手术结束后清醒时间、拔管时间、复苏室停留时间,术后恶心、呕吐并发症发生率比较,差异均有统计学意义（P〈0.05）。术后随访观察组术中知晓情况以及术后认知功能均优于对照组,差异有统计学意义（P〈0.05）;结论：BIS监测技术应用于指导老年腹部手术患者中麻醉药物的使用,有利于提高患者全身麻醉的安全性,促进老年腹部手术患者术后康复。     

平衡麻醉与全凭静脉麻醉在腹腔镜下行子宫切除术中的比较

目的 探讨平衡麻醉与全凭静脉麻醉对腹腔镜下行子宫切除术患者的疗效及影响.方法 将我院2011年1月～2012月12月腹腔镜下行子宫切除术的98例患者作为研究对象,随机将其分为平衡麻醉组和全凭静脉麻醉组各49例,观察指标包括:麻醉药用量、患者清醒时间以及麻醉前、麻醉后,放气前、术后的血氧分压、血压、二氧化碳饱和度进行对比分析.结果 平衡麻醉组术后的心率(HR)、平均动脉压(MAP)要明显高于全凭静脉麻醉组,两组比较差异有统计学意义(P＜0.05);两组患者的动脉血二氧化碳分压(PaCO2)麻醉前的含量要明显高于放气前、术后,差异有统计学意义(P＜0.05);平衡麻醉组的清醒时间要长于全凭静脉麻醉组,但两组比较差异无统计学意义(P＞0.05).结论 全凭静脉麻醉组对腹腔镜下行子宫切除术患者疗效显著,患者清醒时间短.对呼吸功能和血液动力学的影响稳定.值得临床推广应用.     

全凭静脉麻醉与吸入麻醉在腹腔镜胆囊切除术中的应用对比

目的分析全凭静脉麻醉与吸入麻醉在老年急性胆囊炎患者行腹腔镜胆囊切除术中的应用效果。方法选取夏邑县人民医院2016年3月至2017年6月收治的老年急性胆囊炎患者76例,按随机数表法分组,各38例。观察组予以全凭静脉麻醉,对照组予以吸入麻醉。比较两组苏醒质量(拔管时间、术后睁眼时间)和手术前后认知功能(MMSE)评分。结果观察组拔管时间和术后睁眼时间均短于对照组,差异有统计学意义(P<0.05);术前,两组MMSE评分比较,差异无统计学意义(P>0.05);术后1 h两组MMSE评分低于术前,差异有统计学意义(P<0.05);观察组术后1、3、24 h MMSE评分高于对照组,差异有统计学意义(P<0.05)。结论全凭静脉麻醉与吸入麻醉在老年急性胆囊炎患者行腹腔镜胆囊切除术中均可引发术后认知功能障碍,但全凭静脉麻醉可缩短术后睁眼时间与拔管时间,且术后认知功能恢复较快,值得临床推广。     

脑电双频指数监测下丙泊酚闭环靶控输注对妇科腹腔镜手术患者术中知晓和术后恢复的影响

目的 探讨脑电双频指数(BIS)监测下丙泊酚闭环靶控输注对妇科腹腔镜手术患者术中知晓和术后恢复的影响。方法 选取60例行妇科腹腔镜手术的患者作为研究对象,将其随机分为对照组和观察组,各30例。观察组术中采用BIS监测下丙泊酚闭环靶控输注维持麻醉,对照组术中采用BIS监测下手动控制丙泊酚效应室浓度维持麻醉。比较两组患者不同时间点的BIS值、平均动脉压(MAP)、心率,以及患者术中知晓情况、术中丙泊酚用量、术后恢复情况及术后不良反应发生情况。结果 两组患者的BIS值、心率差异均无统计学意义(均P>0.05),而两组患者的MAP差异有统计学意义(P<0.05);两组患者的BIS值、心率均有随时间变化的趋势(均P<0.05);分组与时间均无交互效应(均P>0.05)。两组患者的术中知晓情况及术后不良反应发生率比较,差异均无统计学意义(均P>0.05)。观察组术中丙泊酚用量及术后呼吸恢复时间、苏醒时间、指令反应恢复时间、拔管时间、离室时间均少于或短于对照组,术后语言等级评定量表评分、Ramsay镇静评分均低于对照组(均P<0.05)。结论 在妇科腹腔镜手术中采...     

全凭静脉麻醉与吸入麻醉对老年患者术后认知功能影响的比较

目的 比较全凭静脉麻醉和吸人麻醉对老年患者术后认知功能的影响.方法 选择65岁以上择期行腹部手术的老年患者60例,美国麻醉医师学会分级Ⅰ～Ⅲ级,随机均分为全凭静脉组(T组)、异氟烷组(I组)和七氟烷组(S组).T组术中静脉泵注瑞芬太尼和丙泊酚维持麻醉.I组吸入异氟烷和50%氧化氮(Nz0)维持麻醉,S组吸入七氟烷和50%N2O维持麻醉,术中应用脑电双频指数(BIS)监测镇静深度,并根据BIS值调整用药量,术后进按静脉镇痛泵进行持续镇痛.观察3组患者的血流动力学指标以及术中出血量、输血量和补液量.记录3组患者的手术时间、麻醉时间以及术后睁眼时间和拔管时间.记录3组患者术前及术后1、3、6、24 h各时间点简易智力状态量表(MMSE)评分.结果 3组间的年龄、性别构成比、体重、手术时间、麻醉时间、术中输血和输液量及出血量、各观察时间点生命体征的差异均无统计学意义(P值均＞0.05).I组和S组术后睁眼时间和拔管时间均较T组显著延长(P值均＜0.05).I组的术后睁眼时间和拔管时间略长于S组,但差异无统计学意义(P值均＞0.05).3组间术前MMSE评分的差异均无统计学意义(P值均＞0.05),术后1 h MMSE评分均较术前显著下降(P值均＜0.05),T组患者术后MMSE评分基本恢复至术前水平的时间为3 h,S组为6 h,而Ⅰ组为24 h.结论 全凭静脉麻醉和吸入麻醉用于老年患者,术后短期内均可出现认知功能减退,但全凭静脉麻醉较吸入麻醉恢复更快,吸人麻醉中七氟烷较异氟烷恢复更快.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.